ABSTRACT
Primary malignant melanoma of the vagina is a rare and aggressive disease with worse prognosis as compared with non-genital melanomas or other vaginal malignant neoplasms. Presented here is a case of 42 years female with 3 months history of amenorrhea and vaginal discharge. On vaginal examination, a firm growth of size approximately 7-8 cm was found attached to the left postero-lateral wall of vagina and extending up to the introitus. On biopsy and histopathological examination, it was diagnosed as a case of high-grade malignant melanoma of amelanotic type. Radiotherapy was started as a part of treatment after consultation with an oncologist, considering non-resectable nature of the mass. The patient received first 5 cycles of radiotherapy but succumbed to the disease during treatment.
ABSTRACT
Resumen: ANTECEDENTES: El melanoma vaginal es una alteración excepcional, por lo que el diagnóstico se establece en etapas avanzadas de la enfermedad. El pronóstico a corto plazo es malo y no existen factores de riesgo identificados hasta la fecha. CASO CLINICO: Paciente de 77 años, acudió a consulta por sangrado transvaginal fétido, de dos meses de evolución. Durante la colposcopia se observó una tumoración en la cara lateral izquierda de la vagina, que se extendía hasta su tercio inferior; la cara anterior estaba hiperpigmentada y friable. De acuerdo con el reporte de citología y la biopsia se estableció el diagnóstico de melanoma invasor. La concentración de marcadores tumorales fue positiva para HMB-45, Ki-67 (20%), MART-1 (Melan-1) y PS-100. La paciente fue enviada al servicio de Oncología para estadificación y tratamiento de la enfermedad. CONCLUSIONES: La identificación de una tumoración hiperpigmentada en la exploración ginecológica, además de la biopsia dirigida complementada con estudio de inmunohistoquímica, es sugerente de melanoma vaginal. Las pacientes con este tipo de lesión deben atenderse por un equipo médico multidisciplinario.
Abstract: BACKGROUND: Vaginal melanoma is an exceptional alteration, for which the diagnosis is established in advanced stages of the disease. The short-term prognosis is poor and there are no identified risk factors to date. CLINICAL CASE: 77-year-old patient, who came to the clinic for fetid transvaginal bleeding, two months old. During colposcopy, a tumor was observed on the left lateral aspect of the vagina, which extended to its lower third; the anterior face was hyperpigmented and friable. Based on the cytology report and biopsy, the diagnosis of invasive melanoma was established. The concentration of tumor markers was positive for HMB-45, Ki 67 (20%), MART-1 (Melan-1) and PS-100. The patient was sent to the Oncology service for staging and treatment of the disease. CONCLUSIONS: The identification of a hyperpigmented tumor on gynecological examination, in addition to a directed biopsy, complemented by an immunohistochemical study, is suggestive of vaginal melanoma. Patients with this type of injury should be cared for by a multidisciplinary medical team.
ABSTRACT
Background and purpose:Primary malignant melanomas of the uterine cervix and vagina are rare neoplasms with very poor prognosis. This article aimed at investigating the clinicopathologic characteristics, treatment and prognosis of primary malignant melanomas of the cervix and vagina. Methods:The clinical data of 51 patients with primary malignant melanomas of the cervix and vagina treated at Fudan University Shanghai Cancer Center from Dec.1998 to Jul. 2011 were reviewed. Results:The 2-and 4-year progression-free survival (PFS) rates were 32.8%and 13.1%, respectively. The 2-and 4-year overall survival (OS) rates were 67.2%and 39.8%, respectively. Three patients survived more than 5 years. Twenty-nine (56.9%) patients had a recurrence. The common sites were vaginal stump/pelvis (10 patients, 34.5%), liver (4 patients, 13.9%), lung (3 patients, 10.3%), bone (3 patients, 10.3%) and vulva (3 patients, 10.3%). Larger tumor size and lymphovascular space invasion were the independent predictors of poor OS (P<0.05). Pelvic lymph nodes metastases were associated with shorter PFS (P=0.05). Among them, those who received combined immunotherapy and chemoradiotherapy achieved longer median time to progression (TTP) (17 months) compared with patients who had chemotherapy alone (9 months) or immunotherapy alone (11 months). Conclusion:Primary melanomas of cervix and vagina have a very poor prognosis. The multidisciplinary treatment of combining surgery, chemoradiotherapy, and immunotherapy can improve the patients’ prognosis.
ABSTRACT
A malignant melanoma in the vagina is a rare entity, for which there is little evidence-based literature for guiding clinicians to understand the importance of disease staging via noninvasive imaging strategy. Conventional imaging techniques i.e. computed tomography (CT) may be suboptimal in evaluating a small volume tumour, which may lead to inaccurate staging of a loco-regional tumour. A multimodality imaging exploiting a glucose biomarker, i.e. 18 [F]FDG PET/CT, is being increasingly used for tumour staging, particularly when the other imaging modalities have failed, although its precise role in the T- staging remains to be defined. This paper reports a 51-year-old lady who presented with pervaginal bleeding for 3 months. She has no constitutional symptoms or history of bleeding tendency. Examination of the vagina revealed blood clots without discernible mucosal abnormalities. CT abdomen revealed no perceptible abnormalities aside for an asymmetry of the anterior vaginal fornices. A 18[F]-FDG PET/CT showed a focus of an FDG-avid lesion embedded in the right anterior vaginal fornix without lymphatic or distant metastasis. Histological sections of the tumour lesion confirmed the diagnosis of a primary malignant vaginal melanoma. This report documents the importance of FDG-PET/CT in delineating a small volume tumour which is imperceptible on CT imaging.